ࡱ> OSN bjbj:U:U 76X?gX?g4 >>>>>8<RR-&     >>>,,,,,,,$x/.2V,>>>>>>,>>  4 ->F> > ,>,#)|* W$9j),"-0R-)2*2$**n2> +>>>>>>>,,>>>R->>>>2>>>>>>>>> X : 91 Institutional Review Board (IRB) Form 1 Please complete all of the following questions by clearly indicating which statements apply to your current research proposal and return this form to the IRB by emailing it to IRB@marian.edu. Within 14 days, you will receive information on how to proceed with your research application. All communication to and from the IRB is confidential. Any questions regarding this form may be directed to the IRB Chair. Principal Investigator: Faculty Mentor (if PI is a student): Sponsor (if applicable): Title of Study: Appropriate Subcommittee (based on methodology, not topic; circle one): Social-Behavioral / Biomedical 1. Please provide a 150-300 word abstract describing the nature of your proposed study and the procedures involved: Will your study be a systematic investigation that will result in generalizable knowledge and will be publicly presented (i.e., outside of a classroom activity) or published? Yes No If yes, explain how you intend to present or publish your research results (e.g., Marians undergraduate research conference, national or international professional organization meeting, submission to a professional journal, publication on the internet). Will your study involve obtaining information about or from human subjects? Yes No If yes, explain what type of information and how it will be obtained: Will your study involve human tissues, human cells, or human cell cultures? Yes No If yes, explain what type of human tissues, human cells, or human cell cultures and how they will be obtained: Will your study involve any vulnerable populations, such as children, prisoners, pregnant women, or mentally disabled persons? Yes No If yes, will the study present more than minimal risk? Yes No If yes, explain the nature of the risk involved: Will your study take place only in established or commonly accepted educational settings and involve only normal education practices? Yes No Will your study involve data collection procedures other than surveys, educational tests, interviews, or observation of public behavior? Yes No If your studys participants include children in commonly accepted educational settings, using normal education tests and practices, will you also be collecting data using surveys directed to the children? Yes No Could public disclosure of any identifiable data you collect place the participants at risk of criminal or civil liability, or be damaging to the participants financial standing, employability, or reputation? Yes No Will your study involve only collection of existing data, documents, records, or pathological or diagnostic specimens that are publicly available? Yes No Will your study involve obtaining individually identifiable information from health care plans, health care clearinghouses, or health care providers? Yes No Will your study involve, in any capacity, public benefit or service programs and include participants who are enrolled in such programs? Yes No Will your study involve taste and food quality evaluation or consumer acceptance? Yes No If yes, explain the nature of the food that will be utilized in the study: Will your study involve any of these sensitive subject matters, including but not limited to: Abortion Criminal activity Sexual activity or sexually transmitted diseases Victims of violence Religious or emotional content Yes No If yes, explain which subject matter(s) your study will involve and in what manner: 15. Will your study involve audio or video recording the participants? a. Yes b. No 16. Will your study involve questions about the participants demographics, education, politics, state of mind, cognitive abilities, or opinion? a. Yes b. No 17. Will your study involve questions about the participants health? a. Yes b. 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